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NAN-CHINGChapter One: Vessel Movements & Diagnostic Significance, cont’d.

(Difficult Issues 1-22, here, 7-13).

THE SEVENTH DIFFICULT ISSUE

Overview: Explanation of the significance of the appearance of any of the three yin and three yang

kinds of movement in the vessels as they are related to the six periods within one year.

The seventh difficult issue: (1) The scripture

states: The arrival of the minor-yang [influences]

is at times strong, at times minor, at times short,

at times extended. (2) The arrival of the

yang-brilliance [influences] is at the surface,

strong, and short. (3) The arrival of the

great-yang [influences] is vast, strong, and

extended. (4) The arrival of the great-yin

[influences] is tight, strong, and extended. (5)

The arrival of the minor-yin [influences] is

restricted, fine, and feeble. (6) The arrival of the

ceasing-yin [influences] is in the depth, short,

and generous. (7) Are these six normal

[movements in the] vessels? Or are these

[movements in the] vessels indicative of

illnesses?

(8) It is like this. All these are [indications of] governing [influences moving through the] vessels.

(9) For how many days, and during which months, do the respective influences govern?

(10) It is like this. After winter solstice, during the [first subsequent] chia-tzu [term],1 the minor-yang

[influences] govern. (11) During the following chia-tzu [term], the yang-brilliance [influences]



govern. (12) During the following chia-tzu [term], the great-yang [influences] govern. (13) During

the following chia-tzu [term], the great-yin [influences] govern. (14) During the following chia-tzu

[term], the minor-yin [influences] govern. (15) During the following chia-tzu [term], the ceasing-yin

(influences) govern. (16) All these [influences] govern for 60 days each. Six times six [chia-tzu

terms] add up to 360 days, completing one year. (17) These are the essential points of the three yin

and three yang [influences'] governing at [specific] seasons and [for a specific number of] days.2

Unschuld’s Footnotes

1. A chia-tzu term represents a period of sixty days. Chia is the first of the Ten Celestial Stems, and

tzu is the first of the Twelve Earth Branches. By matching each of the former with each of the latter, a

counting is possible from one through sixty. It was applied to days and years.

2. The wording of sentences 1 through 6 reminds one of the Su-wen treatise "Chih-chen-yao ta-lun,"

which provides one of the most detailed accounts of the wu yün liu ch'i ("five circulatory phases and

six climatic influences") concepts in the Nei-ching and which may, therefore, be a T'ang addition. We

do not have to assume, accordingly, that the present difficult issue represents a later amendment to the

Nan-ching, although this possibility exists, especially if we recall Liao P'ing's claim that the Lü

Kuang commentary does not predate the T'ang era (see above, section I.E.). My rendering here of

sentences 1 through 6 corresponds to three sentences in the Su-wen treatise, "P'ing-jen ch'i-hsiang

lun". The meaning of these three sentences appears isolated; it does not follow the flow of the

argumentation in that treatise. This short passage may, therefore, be either a later addition or an

abridged remainder of a formerly lengthy statement.

THE EIGHTH DIFFICULT ISSUE

Overview: Explanation of the significance of the "moving influences" (also called "vital influences")

in the organism, as appearing at the inch-opening.

The eighth difficult issue: (1) The [movement of the influences in the] vessel at the inch-opening

[displays a condition of] normal balance, and yet [the respective person] dies. What does that mean?



(2) It is like this. All the twelve conduit-vessels are

linked with the origin of the vital influences. (3) The

"origin of the vital influences" refers to the root and

foundation of all the twelve conduits—that is, to the

"moving influences" between the kidneys. (4) These

[influences] are the foundation of the [body's] five

depots and six palaces; they are the root of the twelve

conduit-vessels; they are the gate of exhalation and

inhalation, and they are the origin of the Triple Burner.

(5) They are also called "the spirit guarding against the

evil." (6) Hence, the [moving] influences [between the

kidneys] constitute a person's root and foundation. (7)

Once the root is cut, the stalk and the leaves wither. (8)

In case the vessel [movement] at the inch-opening

displays a condition of normal balance and yet [the

respective person] dies, that is due only to an internal1

cutting off of the vital influences.2


1. "Internal" (nei) refers here to the internal section of the organism— that is, the region below the

diaphragm where liver and kidneys are located.

2. In this difficult issue, the author(s) appear to have limited the all-encompassing validity of the

vessel movement at the inch-opening as a reliable diagnostic indicator (as propagated in the first

difficult issue). The ensuing discussion of its contents by commentators of later centuries mirrors,

once again, historical differences in the interpretation of one and the same term or concept. The fact

that this difficult issue combines, in its wording, a rather large number of hard-to-define concepts

may have contributed to the extraordinarily contradictory nature of the commentaries.



THE NINTH DIFFICULT ISSUE

Overview: How to distinguish illnesses in the depots and palaces by the speed of the movement in

the vessels.

The ninth difficult issue: (1) How can the illnesses in the [body's]

depots and palaces be distinguished?

(2) It is like this. A frequent [movement in the vessels indicates an

illness] in the palaces. (3) A slow [movement in the vessels

indicates an illness] in the depots. (4) Frequency indicates heat;

slowness indicates cold. (5) All yang [symptoms] are [caused by]

heat; all yin [symptoms] are [caused by] cold. (6) Hence, [these

principles] can be employed to distinguish illnesses in the depots

and palaces.



THE TENTH DIFFICULT ISSUE

Overview: Introduction of the concept of "ten variations" in the movement in the vessels, as can be

felt in the different sections at the wrist that are associated with specific depots.

The tenth difficult issue: (1) One [specific

movement in the] vessels may undergo ten

variations. What does that mean?

(2) It is like this. It refers to the five evils1—

that means, to the mutual interference of hard

[evil influences] and of soft [evil influences].

(3) For example, if the [movement in the]

heart [section of the] vessels is very tense,

evil [influences] from the liver have attacked

the heart. (4) If the [movement in the] heart

[section of the] vessels is slightly tense, evil

[influences] from the gall have attacked the

small intestine. (5) If the [movement in the]

heart [section of the] vessels is very strong,

evil [influences] from the heart itself have

attacked the heart.

(6) If the movement in the] heart [section of the] vessels is slightly strong, evil [influences] from the

small intestine itself have attacked the small intestine. (7) If the [movement in the] heart [section of

the] vessels is very relaxed, evil [influences] from the spleen have attacked the heart. (8) If the

[movement in the] heart [section of the] vessels is slightly relaxed, evil [influences] from the stomach

have attacked the small intestine. (9) If the [movement in the] heart [section of the] vessels is very

rough, evil [influences] from the lung have attacked the heart. (10) If the [movement in the] heart

[section of the] vessels is slightly rough, evil [influences] from the large intestine have attacked the

small intestine. (11) If the [movement in the] heart [section of the] vessels is very deep, evil

[influences] from the kidneys have attacked the heart. (12) If the [movement in the] heart [section of

the] vessels is slightly deep, evil [influences] from the bladder have attacked the small intestine. (13)

The body's five depots [and their respective palaces] may all [be attacked by] hardness or softness



evil [influences], and that may cause [the movement on] one [specific level of the] vessels to undergo

ten variations.2


1. The term "five evils" encompasses the five evil influences, originating from five different sources

within the organism, that may be responsible for illness in one specific depot or palace. According to

the Five Phases paradigm, a depot—for instance, the heart—may fall ill by itself, that is, generate its

own evil influences. This would be called a "regular evil" (cheng-hsieh). If influences from the

"mother" phase—in the mutual generation order— invade a depot, this is called a "depletion evil"

(hsü-hsieh). Such influences are considered as coming "from behind." In case of the heart, which

represents the phase of fire, the mother depot "behind" is the liver, which is associated with the phase

of wood. Wood generates fire. If influences from the child phase invade a depot, this is called a

"repletion evil" (shih-hsieh). Such influences are considered as "returning," as coming "from ahead."

In case of the heart, the child depot is the spleen, which is associated with the phase of soil. Fire

generates soil. If influences from a depot associated—in the mutual destruction order—with the phase

that can be overcome invade a depot, this is called a "weakness evil" (wei-hsieh); the resulting illness

will not be serious. In case of the heart, this would be influences from the lung, since the latter is

associated with the phase of metal. Fire destroys metal. If influences from a depot associated with the

phase that cannot be overcome invade a depot, this is called a "destroyer evil " (tsei-hsieh); the

resulting illness is considered to be serious. In case of the heart, this would be influences from the

kidneys, since the latter represent the phase of water. Water destroys fire. The same pattern applies to

the individual palaces, as they are associated with the depots.

2. Although this difficult issue appears to impart straight-forward data, it has, nevertheless, caused

considerable confusion among commentators. In my own view, the answer to the question of

sentence 1 considers each of the five depots to encompass two functional units—namely, the depot

itself and, as its extension, the respective palace. On the basis of the Five Phases paradigm, each of

the two subunits is considered to be vulnerable to five different kinds of evil influences, originating

from five different sources. For a single depot—including the depot itself and its respective palace—

this adds up to ten different variations in the movement of the vessels associated with this particular

depot. This concept of a differentiation of depot and palace as subunits of a depot was not recognized

or accepted by some later commentators. This appears to be one reason for discrepancies in their

statements. Another reason may be found in the vagueness of the diagnostic pattern applied here. In

view of the contents of difficult issue 3, we may infer that the cross-sectional diagnostic pattern was

implied here. That is, the left hand is categorized as yang; its inch-section—which is located "above"

and, hence, represents yang—would be associated with the heart, both being categorized as yang-in-

yang. Accordingly, the foot-section of the left hand would be associated with the lung (yin-in-yang);

the inch-section of the right hand would be associated with the liver (yang-in-yin); and the

foot-section of the right hand would be associated with the kidneys (yin-in-yin). The gate sections of

the left and right hands could be associated with the heart-enclosing network and with the spleen,

respectively, but this is nowhere outlined in detail. Other interpretations of the locations where the



respective movements can be felt are possible, too. Thus, one might think of the movements on the

three (or even five) longitudinal levels associated with the five depots, respectively, as they were

outlined in difficult issues 4 and 5. Even an interpretation neglecting the emphasis that has been

placed thus far on wrist diagnosis could—at least theoretically—be supported by the text of this

difficult issue. The wording would have to be understood literally, referring to examinations of the

individual conduit-vessels themselves in order to find out whether they have been invaded by the evil

influences in question. In this case, the hand-minor-yin and the hand-great-yang conduits—the

former associated with the heart and the latter associated with the small intestine—would have to be

considered as one conduit. Such an interpretation has not been offered explicitly by any of the

commentators, but it could be inferred from Ting Te-yung's commentary (see his comments on

sentences 1 through 13 and note 15), in which two conduits are mentioned as passing through each

section at the wrist. My own rendering of the text, however, follows the cross-sectional pattern.

THE ELEVENTH DIFFICULT ISSUE

Overview: Explanation of the concept that one depot is void of influences if the movement in the

vessels stops once in less than fifty arrivals.

The eleventh difficult issue: (1) The scripture states: If the movement in the vessels stops once in less

than fifty [arrivals], this is because one depot is void of influences.1 Which depot is it?

(2) It is like this. [The influences] a person inhales, enter [the organism] through yin [depots; the

influences a person] exhales leave [the organism] through yang [depots. (3) In this case] now, [the

influences] inhaled cannot reach the kidneys; they return after they have reached the liver. Hence, the

depots which will be void of influences are, obviously, the kidneys; their influences will be depleted

first.2


1. This quotation may refer to Ling-shu treatise 5, "Ken chieh". The wording of the corresponding

sentence there is, ssu-shih tung i tai che i tsang wu ch'i ("when one intermittence occurs after forty

movements, one depot has no influences").

2. The eleventh difficult issue presents a further method for assessing the condition of the body's

functional units on the basis of examining the movement in the vessels at—presumably—the

inch-opening near the wrist. The idea outlined here implies that the normal circulation of influences

through the body can be shortened—in case of an illness—so that at least one depot may be skipped.



The underlying concept was, obviously, borrowed

from the Ling-shu (see note 1), where it is stated

that one, two, three, four, or even all five depots

may be skipped by the circulation. The naming of

the kidneys here, in the Nan-ching, as the first

depot to be avoided by the circulating influences

caused some later commentators to attempt

explanations on the basis of various analogies,

while the more critical conservatives rejected this

innovation altogether because its conceptual

consequences are difficult to reconcile with various

other ideas concerning the supply of the organism

with influences.

THE TWELFTH DIFFICULT ISSUE

Overview: Introduction of the concept that the internal or external parts of the organism may be cut

off from the movement in the vessels.



The twelfth difficult issue: (1) The scripture states: It is contrary

[to the requirements] to employ a needle to fill the external [depots

in case the movement of influences through] the vessels of the five

depots is cut off from the internal [part of the organism]. (2) And it

is also contrary [to the requirements] to employ a needle to fill the

internal [depots in case the movement of influences through] the

vessels of the five depots is cut off from the external [part of the

organism].1 (3) How can one distinguish whether the [movement

through the] internal or external [depots] is cut off?

(4) It is like this. "[The movement of influences through] the

vessels of the five depots has been cut off from the internal [part of

the organism]" means that the vessels associated with the kidneys

and with the liver, located in the internal [part of the organism], are

cut off from the [movement of the] influences. [In this case] a

physician acts contrary [to the requirements] if he fills the

respective [person's] heart and lungs. (5) "[The movement of

influences through] the vessels of the five depots is cut off from

the external [part of the organism]" means that the vessels

associated with the heart and with the lung, located in the external

[part of the organism], are cut off from the [movement of the]

influences. [In this case] a physician acts contrary [to the

requirements] if he fills the respective [person's] kidneys and

liver.

(6) To fill the yin [depots] when the yang [depots] are cut off, or to fill the yang [depots] when the

yin [depots] are cut off, means to replenish what is replete already, and to deplete what is depleted

already, to diminish what is not enough, and to add where a surplus exists already. (7) If anybody

dies due to such [therapies], the physician has killed the respective [patient].2


1. This is a slightly modified quotation, excerpted from treatise 1, "Chiu chen shih-erh yüan" of the

Ling-shu. The original passage in the Ling-shu speaks of wu tsang chih ch'i, rather than of wu tsang

mai. Cf. Hsü Ta-ch'un's commentary.

2. This difficult issue was removed, by Kato Bankei and other Nan-ching editors, from its twelfth

position to become the eighty-first difficult issue. It seems to fit better in the final section of the

Nan-ching, which is devoted to needle therapy, than in the first section, which focuses on diagnosis.

Although my rendering of this paragraph follows this therapeutic interpretation, it should be noted

that a diagnostic rendering would have been possible, too.



Such an understanding is indicated in the Ling-shu treatise 3, "Hsiao-chen chieh", and was referred to

by Hua Shou in his commentary. The innovation presented by this difficult issue appears to have

been the categorization of the two depots (heart and lung) located above the diaphragm as external,

and of the two depots (kidneys and liver) located below the diaphragm as internal. While some

commentators faithfully adopted this idea and attempted to integrate it into the general framework of

systematic correspondence, it was rejected by the critical conservatives who did not find it in the

Nei-ching. The therapeutic principle of filling a depletion and draining a repletion did not create any

controversies because it is propagated also by the Nei-ching. The phrase sun pu tsu i yu yü, in

sentence 6 was quoted literally from Ling-shu treatise 1, "Chiu chen shih-erh yüan."

THE THIRTEENTH DIFFICULT ISSUE

Overview: Introduction of the concept of a correspondence between a person's complexion, the

movement in the vessels as felt at the inch-opening, and the condition of the skin in the foot-section

of the lower arm.

The thirteenth difficult issue: (1) The scripture states: If one sees a [person's] complexion and cannot

feel the corresponding [movement in the] vessels, but rather feels a [movement in the] vessels

[indicating dominance of a superior phase according to the order of] mutual destruction, the

[respective person] will die.1 (2) If one feels a [movement in the] vessels [indicating dominance of a

superior phase according to the order of] mutual generation, the illness will come to an end by itself.2

(3) Complexion and [movement in the] vessels must be compared as to their mutual correspondence,

but how is that done?

(4) It is like this. The body's five depots have five [corresponding] complexions3 which can be seen

on the face. (5) They must also correspond to the [movement felt at the] inch-opening and to [the

condition of the skin of the] foot-interior [section]. (6) For example, [if one sees] a virid complexion,

the respective [movement in the] vessels should be stringy and tense.



(7) In case of a red complexion,

the respective [movement in the]

vessels should be at the surface,

strong, and dispersed. (8) In

case of a yellow complexion,

the respective [movement in the]

vessels should be in the center,

relaxed, and strong. (9) In case

of a white complexion, the

respective [movement in the]

vessels should be at the surface,

rough, and short. (10) In case

of a black complexion, the

respective [movement in the]

vessels should be in the depth,

soft, and smooth. (11) This is

meant by the requirement to

compare the five complexions

with the [movements in the]

vessels as to their mutual

correspondence.

(12) If the [movement in the] vessels is frequent, the skin of the foot[-interior section between elbow

and gate should] also be marked by frequency. (13) If the [movement in the] vessels is tense, the skin

of the foot[-interior section should] also be tense.

(14) If the [movement in the] vessels is relaxed, the skin of the foot[-interior section should] also be

relaxed. (15) If the [movement in the] vessels is rough, the skin of the foot[-interior section should]

also be rough. (16) If the [movement in the] vessels is smooth, the skin of the foot[-interior section]

should also be smooth. (17) Each of the body's five depots has its [corresponding] pitch,

complexion, odor, and taste; they all should correspond to the [movement felt at the] inch-opening

[and to the condition of the skin of the] foot-interior [section]. (18) No correspondence is [a sign of]

illness. (19) For example, [if in case of] a virid complexion the respective [movement in the] vessels

is at the surface, rough, and short, or if [the movement is] strong and relaxed, that indicates

[dominance of a superior phase in the order of] mutual destruction. (20) If [the movement] is at the

surface, strong, and dispersed, or if it is minor4 and smooth, that indicates [dominance of a superior

phase in the order of] mutual generation. (21) The scripture states: The inferior craftsman knows one

[diagnostic sign];5 the mediocre craftsman knows two [diagnostic signs]; the superior craftsman

knows [all] three [diagnostic signs]. That is to say, the superior craftsman cures nine out of ten

[patients]; the mediocre craftsman cures eight out of ten [patients]; and the inferior craftsman cures six

out of ten [patients].6




1. The order of "mutual destruction" or "mutual control" of the Five Phases is wood, soil, water, fire,

metal, since wood (for instance, a spade) controls soil; soil (for instance, a dike) controls water; water

destroys fire; fire destroys metal; and metal destroys wood.

2. The order of "mutual generation" of the Five Phases is wood, fire, soil, metal, water, wood, since

metal generates water; water generates wood; wood generates fire; fire generates soil; and soil

generates metal.

3. In this context, the term se ("complexion") does not denote the color of the entire face but that of

specific sections of the face. See Yü Shu's commentaries to sentences 6 through 10.

4. Kato Bankei and some other Nan-ching editors have exchanged hsiao ("minor") here for ju

("soft"); hsiao may, indeed, be a mistake here. See sentence 10.

5. Later commentators have offered various explanations as to the meaning of "knows one, knows

two, knows three." I have preferred a rather neutral phrasing—namely, "diagnostic sign"—because

"one," "two," "three" might refer, if we stay closest to the preceding discourse, to vessel movement,

pitch, odor, and taste, or to a knowledge of the number of depots involved in an illness. See also note

11.

6. This difficult issue further widens the scope of diagnostic techniques to be applied within the

theoretical framework of systematic correspondence. Its emphasis is twofold. On the one hand, it

outlines a series of physiological signs and processes that correspond to each other and, hence,

should change simultaneously in case one specific depot develops an illness. On the other hand, this

difficult issue demonstrates how the two major sequences of the Five Phases (see notes 1 and 2) may

be utilized to understand clinical pictures characterized by an absence of correspondence between the

physiological signs and processes regarded as perceivable manifestations of internal conditions. The



pattern of correspondences followed by this difficult issue and by its commentators can be tabulated

as above.

The Nei-ching statements referred to by this difficult issue can be found in Ling-shu treatise 4,

"Hsieh-ch'i tsang fu ping-hsing". The differences in the wording and in the underlying concepts were

pointed out by some of the commentators.

dificultate 2

Documents

minoryin influences

greatyang influences

greatyin influences

respective influences

following chiatzu term

subsequent chiatzu term

times minor

following chiatzuterm